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See a sample rate comparisonCPT 26561 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
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| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None LT - Left side of body RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 26561 |
| Medicaid Fee Schedule | View Medicaid rates for 26561 |
National average reimbursement for CPT 26561 by major payers:
$1,267.54
$1,269.51
$1,357.63
$1,588.92
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CPT 26561
5 of 25 sample ratesHigher to lower in this preview
Paramus Endoscopy LLC, Endoscopy Center Of Bergen County
Paramus Endoscopy LLC
$5,327.00Published rateShore Outpatient Surgicenter LLC
$3,507.00Published rateAmbulatory Surgical Center, LLC
Ambulatory Surgical Center LLC
$2,268.00Published rateDermatology & Cosmetic Surgery Center PC
Dermatology Cosmetic Surgery Center PC
$1,300.00Published rateForest Canyon Endoscopy & Surgery Ctr PC
Forest Canyon Endoscopy & Surgery Center, PC
$886.00Published rate
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See a sample payer proposalCPT 26561 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 26561 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 26561 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 26560-CPT | Moderate | Rpair Of Syndactyly (Web Finger) Ea Web Spac; W/ Skin Flaps, Repair Of Syndactyly (Web Finger) Each Web Space; With Skin Flaps |
| 26561-CPT | High | Rpair Of Syndactyly (Web Finger) Ea Web Spac; W/ Skin Flaps, Repair Of Syndactyly (Web Finger) Each Web Space; With Skin Flaps And |
| 26562-CPT | High | Rpair Of Syndactyly (Web Finger) Ea Web Spac; Complx (Eg Invol, Repair Of Syndactyly (Web Finger) Each Web Space; Complex (Eg Involvi |
| 26580-CPT | High | Repair Cleft Hand |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 26561. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 26561 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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